Quantification of Household-Borne Cost associated with Acute Gastroenteritis among Hospitalized children under five in selected hospitals in Kenya

Abstract

Background: Diarrhoea is a leading cause of morbidity and mortality among children less than five years old. Hospitalization for diarrhoea can pose a significant financial burden to families of affected children. Broad Objective: The objective of this study was to quantify household-borne cost associated with acute gastroenteritis disease among hospitalized Kenyan children <5 years old in selected health facilities. Specific Objective: I aimed to estimate direct medical costs associated with acute gastroenteritis disease incurred by households pre-hospitalization. Secondly, I aimed to estimate direct costs (medical and non-medical) incurred by households of the hospitalized children during and after hospitalization. Lastly, I aimed to estimate indirect costs incurred by households of hospitalized children. Methods: We conducted a cross-sectional study in three health facilities: Kenyatta National Hospital, Nakuru County Referral Hospital, and Siaya County Referral Hospital. We enrolled children aged <5 years hospitalized for acute diarrhoea (≥3 looser-than-normal stools in 24 hours, with onset <7 days before admission) from May to September 2018. We interviewed caretakers during admission, on discharge, and 7 – 14 days following discharge/referral. Data were entered via scannable forms and analysed using Epi Info and SPSS statistical software. We calculated median and interquartile range cost of direct medical costs (e.g. medications, diagnostics), non-medical direct costs (e.g. transport, food) and indirect costs (e.g. lost income). Results : Direct medical, non-medical direct and indirect costs incurred by the family, associated with seeking treatment for paediatric diarrhoea were analysed for 227 children. The median total household cost due to diarrhoea treatment was 8,000 Kenya shillings (IQR: 3,150-21,600) and differed by site (p<0.0001): 34,278 Kenya shillings (IQR: 17,680-50,528) in Kenyatta National Hospital, 7,850 Kenya shillings (IQR: 4,560-11,180) in Nakuru County Referral Hospital, and 1,275 Kenya shillings (IQR: 650-3,300) in SCRH. The median direct medical cost to families was 5,000 Kenya shillings (IQR: 800-16,380) and differed by site (p<0.0001): 28,148 Kenya shillings (IQR: 13,775-46,178) in Kenyatta National Hospital, 4,910 Kenya shillings (IQR: 3,060-6,750) in Nakuru County Referral Hospital, and 502 Kenya shillings (IQR: 400-800) in Siaya County Referral Hospital. Median direct non-medical cost was 1200 Kenya shillings (IQR: 450, 2400) overall and differed by site, 2,050 Kenya shillings (IQR: 1,100-5,000) in Kenyatta National Hospital, 1,300 Kenya shillings (IQR: 730-2,200) in Nakuru County Referral Hospital, and 210 Kenya shillings (IQR: 100-400) in Siaya County Referral Hospital. Median indirect cost was 0 Kenya shillings (IQR: 0-3,200) with (p = 0.60) in Kenya National Hospital, 0 Kenya shillings (IQR: 0-2,100) in Nakuru County Referral Hospital and 0 Kenya shillings (IQR: 0-1, 013) in Siaya County Referral Hospital. About 51% of the families reported using savings to pay for care during the diarrheal hospitalization. Conclusion: Households in Kenya bear a substantial direct financial burden for diarrhoea hospitalization. All the costs differed across the three hospitals. Recommendation: A cost analysis benefit for the whole country should be done to guide in policy making for diarrhoea management.